Anorexia nervosa is a chronic illness resulting in significant morbidity and mortality, including the compromised accrual of bone mass during adolescence. Effective prevention and treatment strategies remain unclear. The proposed study focuses on the short-term and long term effects of a novel, nonpharmacologic intervention on bone markers, and the prevention of deleterious changes in bone density and strength in adolescents with AN. The Candidate's long-range career goal is to find a safe, efficacious intervention to prevent the longterm negative effects of this chronic illness on future bone health. Coupled with this goal is a desire to increase understanding of the strategies to prevent bone loss in at-risk pediatric and adolescent patients, and to elucidate the pathways that lead to skeletal deficits in these populations. The proposed career development plan includes additional training and mentorship in 4 areas critical to the Candidate's development as an independent investigator: (1) bone physiology and biomechanics;(2) advanced training in epidemiology and the statistical methods needed to analyze these longitudinal data;(3) use of novel techniques for assessment of skeletal health;and (4) further development of leadership and mentoring skills. The research plan includes 3 aims: (1) To determine the short-term effects of low magnitude mechanical stimulation (LMMS) on bone turnover in adolescents who are hospitalized for AN;(2) To determine the longterm effects of LMMS on bone geometry and bone strength in ambulatory adolescents with a;and (3) To determine the longterm effects of LMMS on biochemical indices of bone remodeling in ambulatory adolescents with AN. The proposed career development plan will provide the training and data necessary to support an R01 application during the later years of the award period. The results of these studies will have broad-reaching clinical importance, as evidence-based treatment protocols will likely stem from these data that result in improved care achieved for adolescents and young women with this common chronic disease. Given the health care burden associated with the current epidemic of osteoporosis in the elderly, establishing effective measures to prevent bone loss during childhood and adolescence is paramount.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Winer, Karen
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Children's Hospital Boston
United States
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Gallagher, Jenny Sadler; Missmer, Stacey A; Hornstein, Mark D et al. (2018) Long-Term Effects of Gonadotropin-Releasing Hormone Agonists and Add-Back in Adolescent Endometriosis. J Pediatr Adolesc Gynecol 31:376-381
DiVasta, Amy D; Feldman, Henry A; O'Donnell, Jennifer M et al. (2017) Effect of Exercise and Antidepressants on Skeletal Outcomes in Adolescent Girls With Anorexia Nervosa. J Adolesc Health 60:229-232
Sadler Gallagher, Jenny; Feldman, Henry A; Stokes, Natalie A et al. (2017) The Effects of Gonadotropin-Releasing Hormone Agonist Combined with Add-Back Therapy on Quality of Life for Adolescents with Endometriosis: A Randomized Controlled Trial. J Pediatr Adolesc Gynecol 30:215-222
DiVasta, A D; Feldman, H A; O'Donnell, J M et al. (2016) Skeletal outcomes by peripheral quantitative computed tomography and dual-energy X-ray absorptiometry in adolescent girls with anorexia nervosa. Osteoporos Int 27:3549-3558
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DiVasta, Amy D; Feldman, Henry A; Sadler Gallagher, Jenny et al. (2015) Hormonal Add-Back Therapy for Females Treated With Gonadotropin-Releasing Hormone Agonist for Endometriosis: A Randomized Controlled Trial. Obstet Gynecol 126:617-27
DiVasta, Amy D; Feldman, Henry A; Beck, Thomas J et al. (2014) Does hormone replacement normalize bone geometry in adolescents with anorexia nervosa? J Bone Miner Res 29:151-7
Divasta, Amy D; Feldman, Henry A; Gordon, Catherine M (2014) Vertebral fracture assessment in adolescents and young women with anorexia nervosa: a case series. J Clin Densitom 17:207-11
Gooding, Holly Catherine; Milliren, Carly; St Paul, Michelle et al. (2014) Diagnosing dysglycemia in adolescents with polycystic ovary syndrome. J Adolesc Health 55:79-84
DiVasta, Amy D; Laufer, Marc R (2013) The use of gonadotropin releasing hormone analogues in adolescent and young patients with endometriosis. Curr Opin Obstet Gynecol 25:287-92

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